再弁置換術の原因，置換弁位別手術成績と置換弁位別遠隔成績の検討

Early and Long-term Results of Cardiac Valve Re-replacement in 217 Patients

　目的：再弁置換の弁位，原因別の早期・遠隔成績を検討した．対象と方法：1980-96年に施行した再弁置換術217例（大動脈弁位36例；A群，僧帽弁位149例；M群，大動脈弁＋僧帽弁位32例；D群）を対象とした．1996年STS/AATSガイドラインに基づき評価した．結果：弁関連eventの平均発生率（A/M/D群）は，弁機能不全1.93/0.65/0，代用弁感染0.48/0.11/0，血栓弁0.48/0.99/1.82，出血0/0.22/1.82％/患者・年であった．早期死亡は6人（2.8％），A/M/D群1（2.8％）/3（2.0％）/2（6.3％）人，原因別では弁機能不全/弁感染/血栓弁4（2.3％）/1（5.2％）/1（1.3％）人，術後8年の実測生存率（A/M/D群）67.4±9.3/76.6±4.1/71.4±9.0％，再々弁置換術回避率100/92.0±2.5/100％，血栓塞栓症回避率94.4±5.4/93.4±2.3/91.5±5.9％，総ての弁関連event回避率69.8±8.7/67.7±4.3/64.8±9.3％と，いずれも差は認めなかった．再弁置換の原因，置換弁位別手術成績と置換弁位別遠隔成績に差を認めず良好であった．

　Background and method : From 1980 to 1996, 217 patients were operated on for valve re-replacement. Using the STS/AATS guidelines of 1996, we compared the early and long-term results of the aortic valve (Group A), mitral valve (Group M) and double (aortic and mitral) valve re-replacement (Group D). Group A consisted of 36 cases, Group M consisted of cases 149 and Group D consisted of 32 cases.

　Results: Early deaths occurred in 6 cases (2.8%). 1 patient was from group A (2.8%), 4 patients were from group M (2%) and 1 patient was from group D (6.3%). The causes were valve malfunction 4(2.3%), valve endocarditis 1(1.3%) and valve thrombosis 1(1.3%) patient. The linealized incidences of valve malfunction, valve endocarditis, valve thrombosis, anticoagulationrelated hemorrhage in Group A/M/D were 1.93/0.65/0, 0.48/0.11/0, 0.48/0.99/1.82, 0/0.22/1.82%/pt-yr. The Group A/M/D's actual survival, re-re-operation-free, thromboembolism-free and freedom from all valverelated events at the 8th postoperative year were 67.4±9.3/76.6±4.1/71.4±9.0, 100,92.0±2.5/100, 94.4±5.4/ 93.4±2.3/91.5±5.9, 69.8±8.7/67.7±4.3/64.8±9.3% respectively. There was no significant difference between each group.